tbuckley/cabot-search huggingface dataset:
Abstract 10170: Comparison of Impella, Intra-Aortic Balloon Pump, and Vasopressors Alone in Patients With Acute Myocardial Infarction and Cardiogenic Shock Undergoing Percutaneous Coronary Intervention
Authors: Awad I Javaid, Joel E Michalek, Imran Aslam, Aleksandra B Gruslova, Serene A Hoskins, Chowdhury H Ahsan, Marc D Feldman
Journal: Circulation (2022)

Introduction: Previous studies have compared Impella to intra-aortic balloon pump (IABP) in patients with acute myocardial infarction and cardiogenic shock (AMI-CS) undergoing percutaneous coronary intervention (PCI) but did not include a cohort of patients receiving vasopressors alone. We assessed the hypothesis that there would be a difference in clinical outcomes in patients with AMI-CS undergoing PCI who received Impella alone, IABP alone, and vasopressor therapy without MCS. Methods: We queried the National Inpatient Sample inclusive of 2015 to 2018 and created three propensity-matched cohorts (Impella alone vs IABP alone, Impella alone vs vasopressors without MCS, and IABP alone vs vasopressors without MCS). We performed propensity matching by adjusting for 21 clinical variables including age, comorbidities, and presence of lactic acidosis. Patients receiving both MCS and vasopressors were excluded, in order to best isolate the effect of each intervention. Results: Among 17,762 hospitalized patients with AMI-CS undergoing PCI, Impella use was associated with significantly higher in-hospital mortality (40.6% vs 27.4%; p=0.003), major bleeding (29.3% vs 13.5%; p &lt; 0.001), acute kidney injury (56.4% vs 45.9%; p=0.04), and hospital charges compared to IABP use (p &lt;0.001) (Figure). Impella patients had significantly higher rates of mortality (42.8% vs 35.5%; p=0.01) and major bleeding (32.7% vs 22.5%; p=0.001), when compared to patients with vasopressors without MCS. There were no significant differences in clinical outcomes between IABP patients and patients receiving vasopressors without MCS. Conclusions: When compared to IABP or vasopressor therapy without MCS, Impella patients with AMI-CS undergoing PCI had higher mortality, major bleeding, and in-hospital costs. A vasopressor-only strategy showed no difference in clinical outcomes when compared to IABP. Randomized trials are necessary to determine optimal MCS management in AMI-CS.
Abstract 10764: A Comparison of Atrial Fibrillation Detection Strategies After Ischemic Stroke- A Retrospective Study
Authors: Salman Salehin, Mohammed Saleh, Peter Rasmussen, Steven Mai, Zaid Safder, Syed Hasan, Khaled Chatila, Wissam Khalife, Asif Sewani
Journal: Circulation (2022)

Introduction: In 20-30% cases, the cause of stroke remained unexplained which has led to coining of the term, Cryptogenic Stroke (CS). Similarly, about 48% cases of transient ischemic attacks (TIAs) had no identifiable cause after standard diagnostic workup. Undiagnosed Atrial Fibrillation (AF) is a prime suspect in CS but guidelines do not recommend initiation of anticoagulation unless AF has formally been detected. Methods: In a IRB approved retrospective study we included patients with at least one episode of ischemic stroke or TIA without identifiable cause and was monitored with either 48-hour Holter Monitor (HM), 30-day Event Monitor (EM) or Implantable loop recorder (ILR) to diagnose any undiscovered AF. All patients had at least 1 year, and up to 3 years, of follow-up after device placement. SAS Version 9.4 was used for statistical analyses. Results: Out of a total of 531 patients, 150 patients were monitored by ILR, 286 by EM and 95 by HM. Primary Outcome- detection of AF. The diagnosis of AF within 1 month of the stroke was 5.59% (16/286), 6.32% (6/95) and 9.33% (14/150) in the EM, HM and ILR cohorts, respectively (p=0.33). At 6, 12 and 24 months, ILRs detected AF in 15.33% (23/150), 16% (24/150) and 20% (30/150) of patients respectively (p=.0017, .0008 and .0001, respectively). Hence the Chi-Squared analysis showed no statistically significant difference among 3 devices for the detection of AF within 1 month of the index stroke but a significant difference in AF detection was observed at 6, 12 and 24 months. Similarly, the multivariable logistic regression model demonstrated no significant difference in capturing AF between HM, EM and ILR within 1 month (p=0.29) but showed a significant difference in AF detection when ILR was compared to HM and EM at 6,12 and 24 months (p=0.0027, 0.0012 and &lt;0.0001 respectively). Secondary Outcome- Kaplan Meier estimator analysis and Cox proportional Hazard model showed device type had no significant impact on secondary outcomes of the study: 1) Subsequent ischemic stroke or TIA 2) Initiation of anticoagulation 3) Mortality 4) Incidence of major bleeding. Conclusion: In conclusion, despite the superiority of AF detection by ILR, it is not superior to HM or EM in lowering the risk of subsequent stroke or TIA, or in reducing mortality.
Abstract 10041: Cardiopulmonary Performance Among Heart Failure Patients Before and After Left Ventricular Assist Device Implantation
Authors: Andrew Baird, Jessica Byrd, Margaret Schulte, William Cornwell
Journal: Circulation (2022)

Introduction: Continuous-flow left ventricular assist devices (CF-LVAD) improve survival and subjective assessments of health-related quality-of-life (HRqOL) when implanted into patients with advanced heart failure with reduced ejection fraction (HFrEF). However, functional capacity remains severely reduced. Hypothesis: LVAD flow during exercise contributes minimally to overall functional capacity. Exercise tolerance depends on intrinsic factors such as cardiac output (Qc) and arteriovenous oxygen difference (avo2 diff ). Methods: Ten patients (9 male, 60±10 years), underwent three invasive cardiopulmonary exercise tests on upright cycle ergometry. Visits were arranged 1) before (median, IQR: 0.3, 0.1-0.05 months) implantation, 2) after (4.2, 3.1-5.3 months) implantation with CF-LVAD speed held constant, and 3) with increases in pump speed during exercise (2.3, 1.9-3.0 months) after Visit 2. Submaximal functional capacity was measured by six-minute hall walk (6MHW). Fick Qc was measured via pulmonary artery catheter and gas exchange parameters determined by indirect calorimetry. Subjective assessments of HRqOL were obtained prior to and following implantation. Results: Following implantation, HRqOL and 6MHW improved. The avo2 diff and Qc predicted Watts achieved during exercise testing pre-implantation. The avo2diff, but not LVAD flow or Qc, predicted Watts achieved on multivariable analysis with both fixed and variable pumps speeds ( Table 1 ). Conclusions: Submaximal exercise performance and subjective HFrEF severity improved post implantation. The primary determinant of workload achieved during exercise testing, regardless of whether participants exercised at a fixed pump speed or with increases in pump speed, was the (A-V)O2 difference. LVAD flow contributes minimally to functional capacity.
Abstract 10005: Pregnancy Complications Are Associated With Premature Coronary Artery Disease - Linking Three South Australian Cohorts
Authors: Adeel Khoja, Prabha H Andraweera, Rosanna Tavella, Tiffany Gill, Margaret A Arstall
Journal: Circulation (2022)

Introduction: There is increasing evidence that women who experience placenta-mediated pregnancy complications and gestational diabetes mellitus (GDM) are more likely to develop coronary artery disease (CAD) at a younger age. This is the first study to assess the relationship between pregnancy complications and premature coronary artery disease (PCAD) in Australian women. Hypothesis: We hypothesized that there is an association between placenta-mediated pregnancy complications, GDM and risk of CAD prior to 60 years of age. Methods: The research project involved a data linkage approach merging three databases of South Australian cohorts by employing a retrospective, age-matched case-control study design. Cases (n=721) were ascertained from Coronary Angiogram Database of South Australia (CADOSA). Women &lt;60 years from CADOSA were linked to South Australian Perinatal Statistics Collection (SAPSC) to determine their pregnancy outcomes. Controls (n=194) were ascertained from North West Adelaide Health Study (NWAHS) and comprised of women who were healthy or had health conditions other than CAD, age-matched to CADOSA (+/- 5 years) and linked to SAPSC to determine their pregnancy outcomes. PCAD was defined as &gt; 50% stenosis in one or more coronary arteries at coronary angiography. Results: Women who were diagnosed with PCAD were more likely to have experienced a placenta-mediated pregnancy complication, previous miscarriage, asthma or anaemia and/or have risk factors for CAD including pre-existing diabetes (I &amp; II), active smoking and obesity during pregnancy compared to women without a history of CAD as shown in the table below (p &lt; 0.05). GDM was not associated with PCAD in these cohorts. Conclusion: Women diagnosed with PCAD have conventional CVD risk factors and some that are uniquely related to their pregnancy. These clinical events may be considered novel risk factors for future PCAD and require attention in contemporary preventative cardiology practice.
Abstract 10677: A Systems Biology Approach Demonstrating the Association Between Mir 122-5p and Glutamine Metabolism With Cardiovascular Health in Black Adults: Results From the Morehouse-Emory Cardiovascular (meca) Center for Health Equity
Authors: Shabatun Islam, Chang Liu, Nour Beydoun, Appesh N Mohandas, Kimberly Rooney, Aditi Nayak, Anurag Mehta, Herman A Taylor, Yan Sun, Dean Jones, Arshed A Quyyumi, Charles D Searles
Journal: Circulation (2022)

Intro: Integrative analysis of extracellular microRNA (miRNA) and metabolomics is a novel approach to identifying molecular pathways underlying cardiovascular health (CVH). Levels of miRNAs are linked to cardiovascular disease (CVD), while cardiometabolic risk factors are known to alter activity of select metabolic pathways. We identified miRNAs and metabolites underlying CVH in a cohort of Black adults through an integrative analysis of extracellular miRNA levels, metabolite concentrations and clinical factors associated with CVH. Methods: The MECA cohort consisted of 371 Black adults (age 53+10, 38.5% male) without known CVD. CVH was determined by Life’s Simple 7 (LS7) score, calculated from blood pressure, fasting glucose, cholesterol, BMI, exercise, diet, and smoking. Metabolite concentrations in plasma was assessed by high-resolution metabolomics profiling, and expression of miRs-122-5p, -150-5p, and -30c-5p was assessed by RT-qPCR. Metabolome wide association study (MWAS) identified metabolites associated with LS7. Association of miRNA levels with CVH clinical domains was assessed using Spearman correlation. Integrative analysis of select miRNAs, metabolites, and CVH clinical domains was performed using the program xMWAS. Results: Expression of 30 metabolites was associated with improved CVH (FDR&lt;0.2) where glutamine was higher (p=0.005), and glutamate was lower (p&lt;0.001). Integrative analysis showed association between miR-122-5p, glutamine and fasting glucose. miR-122-5p expression independently correlated with fasting glucose (p=0.03) and glutamine/glutamate is known to be associated with glucose metabolism. In silico and in vitro analyses revealed glutamine synthetase as a potential target of miR-122-5p (Fig). Conclusions: We demonstrate novel associations between glutamine, miR-122-5p and fasting glucose in CVH, suggesting that select metabolites and miRNAs are markers of CVH and maybe potential therapeutic targets.
Abstract 10615: The Effects of Maternal Hypothyroidism on Progeny Cardiac Development and Disease Susceptibility
Authors: Yijia Li, Yijun Yang, Jaslyn Johnson, Michael Foster, Hajime KUBO, Remus Berretta, Xiongwen Chen, Xiongwen CHen, Steven R Houser
Journal: Circulation (2022)

Introduction: Maternal hypothyroidism (MH) is a common clinical condition with high prevalence. MH is thought to have adverse effects on progeny's cardiac development and disease susceptibility. Hypothesis: MH impacts progeny's postnatal cardiac development and the susceptibility to adverse cardiac disease responses as adults. Methods: MH model was induced by thyroidectomy (TX) with total thyroxine (TT4) under 1ng/dl after surgery. Offspring of mice that underwent TX or Sham surgery was termed THD (Deficient) and THN (Normal) animals. Hearts were collected from THD and THN animals to determine heart weight, cardiomyocyte (CM) size, and CM proliferation. Transverse Aortic Constriction (TAC) was performed to induce pressure overload-induced cardiac hypertrophy and/or heart failure (HF) model in adult THD and THN mice. ECHO (in-vivo) and histological (in-vitro) were performed at specific times after TAC. RNA-seq was performed at embryo day (E) 18.5 and Postnatal day 5 (P5) using heart tissue. Results: The postnatal TT4 level was not different between the THD and THN mice. The heart weight (HW) to body weight (BW) ratio was similar between the two groups on P7, P14, and P60, but the THD mice had larger CM sizes. EdU+, Ki67+, and PH3+ CMs were lower in THD progenies on P0, P5, and P13. RNA-seq data showed that the genes related to cell division and DNA replication were downregulated in THD mice on E18.5 and P5, respectively. In adult animals six weeks after TAC, the THD mice had a greater HW/BW ratio and lung weight(LW) to BW ratio, consistent with more severe cardiac hypertrophy and HF than the THN mice. After TAC, THD mice had a lower LVEF, higher absolute E/e' ratio, greater end-diastolic pressure, and more severe LV fibrosis than THN mice. Conclusions: Alterations in CM proliferation during fetal and early postnatal development results in fewer adult CMs in animals from MH mothers. These changes are associated with increased disease susceptibility in adult MH progeny.
Abstract 10066: Clonal Hematopoiesis of Indeterminate Potential is Not Associated With Incident Atrial Fibrillation
Authors: Navid A Nafissi, Jessica A Regan, Lydia C Kwee, William E Kraus, Alexander G Bick, Pradeep Natarajan, Siddhartha Jaiswal, Svati H Shah
Journal: Circulation (2022)

Introduction: Inflammation is involved in the initiation and maintenance of atrial fibrillation (AF). Clonal hematopoiesis of indeterminate potential (CHIP) increases cardiovascular risk through pro-inflammatory mechanisms. Hypothesis: The presence of CHIP is associated with increased risk of incident AF. Methods: Individuals with AF were identified from the CATHGEN cohort, a study of 9,334 sequential individuals undergoing cardiac catheterization at Duke University Hospital, using ICD-9/10 codes and ECG interpretations. Incident AF was defined as AF diagnosed after blood sample collection. Individuals with predisposing or provoking conditions leading to AF (i.e., cardiomyopathy, valve disease, congenital heart disease, thyroid disease, and recent STEMI or cardiac surgery) were excluded. The remaining individuals with incident AF were matched 1:1 to controls without an AF diagnosis based on age, sex, ancestry-defined race, BMI, diabetes, hypertension, and smoking status. Whole exome sequencing was performed in DNA extracted from whole blood, and CHIP carriers in 68 genes of interest were identified. Results: Among 1,716 individuals with incident AF, 335 had no predisposing or provoking conditions leading to AF. Among these individuals, 17 (5.1%) were CHIP carriers, compared to 18 (5.4%) matched controls (odds ratio, 0.94; 95% confidence interval [CI], 0.48-1.86; p =0.9). Ten individuals (3.0%) with incident AF were carriers of a CHIP clone with variant allele fraction &gt;10%, compared to 11 (3.3%) matched controls (odds ratio 0.90; 95% CI, 0.37-2.22; p =0.8). Restriction to the two most common genes ( DNMT3A or TET2 ) also did not show an association between CHIP and AF ( Table 1 ). Conclusions: There is no association between CHIP carrier status, high burden of CHIP, or CHIP in DNMT3A or TET2 and incident AF in the CATHGEN cohort.
Abstract 10112: Association of Coronary Artery Disease Testing During Index Hospitalization for New-Onset Heart Failure With Thirty-Day Readmission Rates and Mortality
Authors: Sun-Joo Jang, Fabricio Malaguez Webber, Ilhwan Yeo, Edward R Pinto, Adrian Da Silva De Abreu, Michelle M Kittleson, Stuart Zarich
Journal: Circulation (2022)

Introduction: Testing for coronary artery disease (CAD) is recommended for patients with new-onset heart failure (HF). There are limited data on the association between testing for CAD during index hospitalization for patients with the new-onset HF and early readmission rates and readmission mortality. Hypothesis: CAD testing for new-onset HF during index hospitalization may reduce 30-day readmission rates and readmission-related mortality. Methods: Patients hospitalized for new-onset HF were identified from the Nationwide Readmission Database of the United States. Clinical characteristics, 30-day readmission rates, readmission-related mortality were compared in patients with or without testing for CAD during index hospitalization. CAD testing includes coronary angiography, coronary CT angiography, cardiac MRI, nuclear imaging or cardiac stress test. Results: Between January 2016 and November 2019, of 151,172 patients hospitalized for new-onset HF, 30,444 (20.1%) patients underwent testing for CAD during index hospitalization. Younger patients, males, and patients with HF with reduced ejection fraction (HFrEF) had more frequent testing for CAD. Only 9.5% of CAD-tested patients received percutaneous coronary intervention during the index hospitalization. Patients with CAD testing had lower 30-day readmission rates than those without testing (11.4% vs 14.3%, P&lt;0.001; adjusted odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76 to 0.87). Patients with CAD testing had lower 30-day readmission-related mortality rates than those without testing (0.5% vs 0.9%, P&lt;0.001; adjusted OR 0.82, 95% CI 0.65 to 1.04). Readmission rate for HF at 30 days was 2.3% for patients with CAD testing vs 3.5% for those without testing (P&lt;0.001; adjusted OR 0.67, 95% CI 0.59 to 0.76). There was a significant interaction between HF type (HFrEF vs HF with preserved EF) and CAD testing on 30-day readmission rates (P for interaction &lt;0.001). Conclusions: Testing for CAD during index hospitalization for patients with new-onset HF was associated with reduced 30-day readmission rates. There was substantial decrease in readmission for HF and readmission-related mortality in patients who underwent CAD testing during index hospitalization.
Abstract 10020: Statins Are Associated With Lower Adjusted In-Hospital Mortality in Patients With COVID-19
Authors: William J Kostis, Stavros Zinonos, Abel E Moreyra, Javier Cabrera, John B Kostis
Journal: Circulation (2022)

Introduction: There are more than 250,000 publications on COVID-19. However, there is incomplete information on the effects of pharmacologic therapy in hospitalized patients. Hypothesis: We hypothesize that use of statin therapy will decrease all-cause mortality in patients hospitalized for COVID-19. Methods: A dataset of 1,064 patients with first admission for COVID-19 was used in this study. Predictive models using logistic regression, support-vector machines, and neural networks were used to predict all-cause in-hospital death. Results: In-hospital case fatality of patients admitted with COVID-19 was 17.5% and was higher in the first week after admission, among older individuals, those with higher body weight, and those with longer length of stay. The use of statins was associated with lower in-hospital mortality after adjustment for other medications and the factors mentioned above. The beneficial effect of statins may not be due to their effects on lipids but is probably due to their pleiotropic antioxidant effects. Using logistic regression, the duration of therapy was positively related to the beneficial effect of statins (p=0.0002). Conclusions: In conclusion, the in-hospital case fatality of COVID-19 patients was lower in patients receiving statins after adjustment for demographics, other medications, body weight, and length of stay (Figure).
Abstract 10006: The Effect of Dapagliflozin on Hospital Admissions in Patients With Type 2 Diabetes: Post Hoc Analysis of the DECLARE-TIMI 58 Trial
Authors: Meir Schechter, Stephen D Wiviott, Itamar RAZ, Erica L Goodrich, Avivit Cahn, Anna Maria Langkilde, Ingrid A Gause-nilsson, Marc S Sabatine, Ofri Mosenzon
Journal: Circulation (2022)

Background: In the DECLARE-TIMI 58 trial, involving patients with type 2 diabetes at high cardiovascular (CV) risk, dapagliflozin reduced the risk for heart failure hospitalization and adverse kidney outcomes, compared to placebo. Whether dapagliflozin lowers the risks for the broader outcome of adverse event (AE)-related hospital admissions is unknown. Methods: The DECLARE-TIMI 58 trial randomized 17,160 subjects with type 2 diabetes and a high risk for or established CV disease, to receive dapagliflozin or placebo (1:1). Dapagliflozin effect on AE-related hospital admissions was assessed overall and by baseline cardiovascular and kidney subgroups. Investigator reported system organ class classification was used to evaluate dapagliflozin's effects on admissions due to different etiologies. Results: Over a median follow up of 4.2 years, dapagliflozin reduced the risk of AE-related hospital admissions by 11% (32.4% vs. 35.4% of participants, HR 0.89 [95% CI 0.85, 0.94]; p&lt;0.0001). The reduction in AE-related hospital admissions was consistent across baseline cardiovascular and kidney subgroups (p-interaction≥0.30) (Figure). Dapagliflozin reduced the risk for admissions due to cardiac disorders (HR 0.91 [95% CI 0.84,0.995] p=0.0387), renal or urinary disorders (0.61 [0.49, 0.77] p&lt;0.0001), and other non-cardiac, non-renal etiologies (0.89 [0.84,0.95] p=0.0001). Conclusion: Dapagliflozin reduced the risk for AE-related hospital admissions, including non-cardiac and non-renal hospitalizations, in patients with type 2 diabetes. These findings have implications for patients' quality of life and overall type 2 diabetes-attributed healthcare burden.